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Background: For the treatment of the symptoms of post-COVID-19 syndrome, no causal therapy is currently widely recommended according to evidence-based criteria. The overarching goal of the intervention study over a 3-year period (Q1-2021-Q4-2023) was to evaluate the changes in the key symptoms of fatigue and sensorimotor instability through individualized stress-controlled training therapy and through intensified cognitive behavioral therapy.

Material and methods: In the 3‑year period 407 vaccinated nucleocapsid positive patients were treated at the Post-COVID-19 Center Lausitz (Senftenberg). In 78 (around 19%) fatigue/immunometabolic depression and sensorimotor instability were identified as the leading syndromes. The evaluation of the individualized stress-controlled training therapy was based on the specific post-COVID-19 syndrome and motor fatigue parameters. The secondary psychosomatic syndrome was assessed using cognitive fatigue parameters and cognitive behavioral therapy instruments. The investigation of -parameters influencing behavior took place in Q2-2023-Q4-2023 with a guide-supported qualitative interview among the participants.

Results: The post-COVID-19 key symptoms "fatigue," "sensorimotor instability," "neuropsychiatric symptoms," "cardiac/autonomic dysfunction," and "pain" improved significantly in the overall cohort and in the gender-specific analysis. A deterioration occurred in "secondary psychosomatic symptoms". A therapeutic effect was demonstrated for all motor fatigue parameters for the entire cohort using the Cohen's d value. An intensification of cognitive behavioral therapy achieved positive effects through an increasing development of the patients' own activity and their self-control using persuasion and gamification.

Background: Guidelines serve as practice-based decision support and recommend the use of standardized instruments to measure functional capacity in individuals with multiple sclerosis (MS). However, the extent to which a person's functioning is captured by these instruments is unclear.

Objectives: The aim of this study is to link the content of the MS disease guideline with the International Classification of Functioning, Disability and Health (ICF) in order to capture the distribution of the content on the functional domains and contextual factors and to uncover existing gaps.

Materials and methods: Instruments of the S2k guideline "Diagnosis and therapy of multiple sclerosis, neuromyelitis optica spectrum diseases and MOG-IgG-associated diseases", which were available free of charge in German or English and designed for adult people, were included. The instruments were classified into their meaningful concepts (meaningful concepts = MCs) and subsequently coded using standardized ICF rules by two raters.

Results: The 23 included instruments contained 351 items and 718 MCs. Of these, 663 MCs could be linked to the ICF according to the coding rules. Of these, 51% (340 MCs) related to body functions, 44% (291 MCs) to the activity and participation component, and 5% (32 MCs) to environmental factors. The most frequently coded chapter was mobility (d4) with 201 MCs. Interrater agreement was k = 0.79.

Discussion: The linking of the guideline-recommended instruments to the ICF shows that the instruments cover different themes. The area of environmental factors is underrepresented. The ICF linkage reveals a broad spectrum of functioning covered by the guideline-recommended instruments and facilitates the selection of appropriate instruments for the affected persons.

Background: Visual snow is a disorder of visual perception that is manifested as a constant flickering or "TV-like" noise in the entire visual field. Visual snow syndrome (VSS) describes a combination with other additional visual symptoms, such as sensitivity to light, afterimages, night blindness and entoptic phenomena. Cases of VS have been described in the literature using a wide variety of terms, often misunderstood as persistent migraine aura. Established diagnostic criteria have existed for more than 10 years now; however, the pathophysiology is still incompletely understood. The exact prevalence also remains unknown and high numbers of unreported cases are suspected. This is the first detailed description of a cohort of VSS patients from Germany.

Methods: Patients with VSS from several studies conducted at our center were pooled and retrospectively evaluated with respect to demographic, epidemiological and clinical data.

Results: In this study 66 patients with VSS were included (age 31.3 ± 8.3 years, 30 women). The most commonly associated visual symptoms were photophobia (67%) and afterimages (65%). Of the patients 36 (54%) had comorbid migraine of whom 25 (70%) had migraine with aura, 26 (39%) reported depressive symptoms and 32 (48%) symptoms of an anxiety disorder. Tinnitus was reported by 32 (48%) patients.

Conclusion: The characteristics of the German cohort described here are similar to other international descriptions. Due to the frequent psychological comorbidity there is still a risk of psychosomatic stigmatization.

Background: Longitudinal outcome studies confirm that the majority of patients with schizophrenic psychoses develop cognitive impairments associated with schizophrenia (CIAS).

Objective: To provide an overview of the epidemiology, diagnostics and evidence for various treatment options for CIAS.

Material and methods: Literature review of the current level of evidence regarding the efficacy of different treatment strategies for CIAS.

Results: Up to 85% of patients with schizophrenic psychoses exhibit CIAS, in some cases even before the development of positive or negative symptoms. The CIAS are associated with extensive individual burden due to impairments in many areas of cognitive and psychosocial functioning relevant to daily life. Various test instruments are available for clinical assessment with the Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus cognitive battery (MCCB) as an established standard for clinical trials and special clinical issues. The treatment of CIAS warrants a multimodal approach with non-drug strategies (e.g., cognitive remediation, exercise) currently providing the best level of evidence. Noninvasive neurostimulation procedures and dopaminergic antipsychotic drugs of the first and second generations have demonstrated low effectiveness on cognitive function disorders in schizophrenic psychoses.

Conclusion: The CIAS is a frequent disease-immanent symptom in schizophrenic psychoses that should be considered in the clinical routine as it substantially impairs those affected in the functional level and quality of life. Current treatment options are limited but innovative psychosocial interventions show low to moderate effects. In addition, new medications developed based on current neurobiological findings and combinations with psychosocial and neurostimulation procedures could open up new perspectives.

Background: Safety or emergency plan interventions, i.e., the creation of a list of hierarchically organized strategies and persons/institutions that patients can use or contact in case of a suicidal escalation, are increasingly used in clinical practice.

Method: This narrative review describes the approach for establishing an emergency plan and discusses studies on the effectiveness of such interventions. In addition, ideas on the mode of action of corresponding interventions and application variants are discussed.

Results: Despite increasing dissemination of safety plans, empirical evidence of their effectiveness is currently inadequate.

Discussion: High-quality studies are urgently needed, particularly with respect to different clinical populations. At this point in time, it should be cautioned against understanding the creation of an emergency plan as a sufficient intervention in dealing with suicidal patients.